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Canada needs over 20,000 more nurses but the national demand is masked by delayed retirements and heavy workloads, say professionals in the field.

“There is a substantial nursing shortage,” says Stephen Bishop, chair of the nursing department of Camosun College in Victoria, B.C. “It is a bit hidden right now because some people are not retiring from nursing — I would say that is related to the economic situation — but it will become more obvious in the next couple of years.”

Mandy Perrier, a nurse at the Almonte General Hospital, Ont., has been in the field for 50 years and continues to work part-time. “I have worked part-time since my son was born, but sometimes it is like working full-time hours,” she says. “I find a lot of things are done better than they were just because we know more now, but sometimes it is more stressful because a lot more is expected of us.”

Many nurses work part-time because they find it so exhausting when they get into the workplace, says Judith Shamian, president of the Canadian Nurses Association (CNA). “But, we are currently short of around 22,000 nurses. We compensate for that by having a lot of nurses doing a lot of overtime, which leads to other concerns.”

She cites a recent study of the fatigue level among nurses conducted by the CNA, which she says demonstrates that “nurses end up being far sicker than the rest of the population, so that absentee days in comparison with the general public are much higher. That’s what happens when you keep working very long shifts and come to a point of exhaustion.”

A study of nurses’ working conditions published by Statistics Canada in 2008 found strong links between medication error and both work organization and workplace environment, including “working overtime, role overload, perceived staffing shortages or inadequate resources, poor working relations with physicians, lack of support from co-workers and low job security.”

The current situation adds to the financial load on the system, Shamian says, because “it also leads to a very high turnover — an average of 20 per cent across the country in acute care. This is very expensive. Each one costs $25,000 to replace. All in all, we are spending good money to buy illness among nurses.”

The three main reasons that nurses leave their jobs, she says, are that “they are exhausted, they feel their jobs make them sick and, above all, they leave because they feel they can’t do all they want to do for their patients.”

"Hospitals spend an awful lot on overtime and turnover when they could take those same dollars and open additional full-time positions and recruit some new graduates,” she adds. “This would guarantee feeding into the pipeline.”

This approach would help shorten waiting lists to enter training programs, says Bishop. “We take 200 students a year for a four-year BSN program in partnership with the University of Victoria and our program is fully subscribed,” he says. “Over the past five years, we have increased to the largest intake we’ve ever had, but there is still a two- to three-year wait list to get in. Camosun also has a licensed practical nurse program and a health care aide program and both of those have increased in the last year, too.”

However, he adds, “the nursing population is aging — as is the rest of the population — so we are going to see a resumption of retirements and, at the same time, we are going to see an increase in the load on the health care system as the boomers age and retire and need more health care resources.”

The demand for care in nursing homes and at home is also going up, says Shamian, who has been the chief executive officer of the Victorian Order of Nurses Canada for the last seven years.

“This is very challenging on several counts,” she says. “For example, nurses in Ontario who choose to work in home care get paid 10 to 15 per cent less than if they work in a hospital. The demand for home care is constantly going up and the supply is going down because funding is not keeping up with the demand. Therefore, provinces ration it and spread it more thinly.”

For instance, she says, if in the past five home visits were allotted to deal with a particular health issue, today the number is reduced to three.

According to a report released by the Canadian Institute for Health Information in December 2010, Canada has 266,341 registered nurses — an increase of six per cent since 2005 — with the majority working in hospitals. Despite the boost in the number of nurses, as well as a reported 10-year high in students entering nursing programs, the Canadian Nurses Association predicts a shortage of some 60,000 registered nurses by 2022.

“This is a very serious issue,” says Shamian. “We don’t necessarily need more money in the system. We need federal and provincial governments to have the moral and political will to work through the issues. The question we need to bring to the table is ‘what needs to happen to deliver optimum health care to Canadians?’”

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